Provider Demographics
NPI:1669955175
Name:PENDEL, MICHELLE COURTNEY (RD, LDN, CSSD)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:COURTNEY
Last Name:PENDEL
Suffix:
Gender:F
Credentials:RD, LDN, CSSD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:COURTNEY
Other - Last Name:LAGREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN, CSSD
Mailing Address - Street 1:5750 BAUM BLVD # 306
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3793
Mailing Address - Country:US
Mailing Address - Phone:412-593-2048
Mailing Address - Fax:844-311-7396
Practice Address - Street 1:3 ROBINSON PLZ # 205
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1024
Practice Address - Country:US
Practice Address - Phone:412-593-2048
Practice Address - Fax:844-311-7396
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004925133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039241240001Medicaid